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ABSTRACT
Background
Rational prescribing is key to optimising therapeutic outcomes and avoiding risks associated with irrational use of medicines. Using WHO drug use indicators, this study evaluated drug use patterns among paediatric outpatient encounters at Primary Healthcare Centers (PHCs) in Bujumbura Mairie, Republic of Burundi.
Methods
Descriptive cross-sectional research assessed paediatric medicine use in 20 PHCs. From 8 February to 7 April 2023, 800 randomly selected paediatric encounters’ 2022-year data were retrospectively collected. Data for specific facility indicators were prospectively collected. SPSS 23 was used to analyse data.
Results
800 outpatient child encounters were analysed, 48.4% female and 51.6% male. The mean number of medicines per encounter was 2.4(±0.99). The injection rate was 9.9%. Overall, 78.8% of generics and 85.2% of essential medicines were prescribed. Results show drug prescribing differences between private and government PHCs (p < 0.001). All PHCs studied had no standard treatment guidelines (STGs), while 50% had an essential medicine list (EML) and 85% of key medicines were available.
Conclusion
Poor prescribing practices were found indicating the need for interventions to promote good drug use practices. A large study at a national scale is required to provide a more comprehensive understanding of the overall drug use practices.
Acknowledgement
The authors of this manuscript would like to extend their sincere gratitude to the authorities of Bujumbura Mairie health province and the administrators of the 20 healthcare centres that had permitted the study to be carried out in their health facilities.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Availability of data and materials
Dataset is available and can be shared.
Ethics approval and consent to participate
Before collecting data, permission was first provided by the authorities of the health province of Bujumbura Mairie on 20 January 2023, and then ethic approval was obtained from the Institutional Ethics Committee of the National Institute of Health of Burundi for the protection of human participants in biomedical and behavioural research on 7 February 2023, with decision number CIE/04/2023. In addition, participant consent didn’t apply since all data were collected from historical healthcare records.
Author’s contribution
Authors contributed to all aspects of this manuscript, from initial conception and design to the final draft. Each author who contributed to the manuscript's final version has reviewed and approved it.
Additional information
Notes on contributors
Audace Manirakiza
Audace Manirakiza is a Pharmacist and an Alumni from the Masters' degree in Health Supply Chain Management (2020–2022) at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management (EAC RCE-VIHSCM), College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. He holds a Bachelor of Pharmacy degree from Institut National de Santé Publique du Burundi (2015–2018). In addition, he also holds a Senior Technician of Pharmacy degree from Institut National de Santé Publique du Burundi (2003–2005). Audace is a researcher, and independent consultant in the areas of health supply chain management (from 2023). Audace is a Pharmacist by profession with 16 years' experience working in the public pharmaceutical sector at the National Tuberculosis Program (NTP) of Burundi within the Ministry of Health (MoH). He is the Chairman of the Department of the Purchasing and Inventory Management for TB Products at Burundi NTP, where he is employed.
David Gitonga Nyamu
David Gitonga Nyamu, BPharm, MBA, MPharm, Fellow (UoN), PhD, is Clinical Pharmacist & an Associate Professor of Clinical Pharmacy at the Department of Pharmacology, Clinical Pharmacy & Pharmacy Practice, University of Nairobi (UoN), Kenya. He is also the Unit Head and Academic Lead in Clinical Pharmacy at UoN. He has pursued implementation Science Fellowship (ISF) and has a Master of Business Administration (MBA) in Strategic Management. He teaches and supervises both undergraduate and postgraduate pharmacy students. In addition, for over 17years, David has been practicing Clinical Pharmacy at Kenyatta National Hospital (KNH), the University's Teaching & Referral Hospital, which is also the largest referral health facility in Eastern and Central Africa. His specialties include pharmacotherapy in internal medicine, emergency and critical care pharmacy, implementation science and strategic management. He has supervised over fifty postgraduate students to completion and co-authored over 60 papers in peer-reviewed journals. David is registered with the Pharmacy and Poisons Board (PPB) of Kenya and is a Member of the Pharmaceutical Society of Kenya (MPSK), Hospital Pharmacists Association of Kenya (HOPAK) and Clinical Pharmacists Association of Kenya (CPAK). He has previously worked as a provincial hospital pharmacist and also in two leading community pharmacies (in Nairobi, Kenya) as a consultant pharmacist. Before joining academia, he worked as a Training Manager at the Mission for Essential Drugs & Supplies (MEDS), a faith based non-governmental organization, which procures and distributes pharmaceuticals to all mission hospitals and charitable organizations in Kenya. Prof. Nyamu holds a gold medal for the best final year pharmacy student in Kenya. His professional objective is to develop a career in teaching and research specializing in clinical pharmacy as well as the provision of high quality, safe and effective pharmaceutical care services to the global community.
Shital Mahindra Maru
Prof. (Dr) Shital Mahindra Maru is an Associate Professor of Pharmaceutics at the Department of Pharmaceutical Chemistry, Pharmaceutics and Pharmacognosy at the Faculty of Health Sciences, University of Nairobi, where she has worked for more than 20years training Pharmacists. Prof. (Dr) Maru is a registered and Practicing Pharmacist at the Pharmacy and Poison's Board of Kenya (PPB) Extensive experience in academic teaching, academic coaching and mentoring, curriculum development and research in a higher education institute (HEI) for over 20 years. She has been the former Chairman of the Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy at the College of Health Sciences, University of Nairobi (2010 to 2020) and the acting Dean, School of Pharmacy, University of Nairobi (2020–2021). She hold a Bachelor of Pharmacy degree from Karnataka University, India (1993–1997), a M.Pharm in Pharmaceutics from Rajiv Gandhi University, India (1997–1999), MBA from University of Liverpool, UK (2006–2008), PhD in Pharmaceutics under the Commonwealth Commission Scholarship at Institute of Pharmaceutical Innovation (IPI) now Centre for Pharmaceutical Engineering at The University of Bradford, UK and University of Nairobi (2008–2012). She has published widely in several high impact journals over the years and has supervised many postgraduate and Doctoral students to completion. She has her expertise in pharmaceutics research development using innovative/novel technologies for drug delivery, especial in pediatric formulation and cosmetic formulations development using Quality by Design (QbD) and Process analytical technology (PAT) concepts, developing Pharmaceutical quality assurance (QA) systems and Pharmaceutical Quality management systems (QMS), Pharmaceutical Risk management systems, WHO cGMP and GxP(GLP/GDP, GSP,, ICH guidelines and regulation, implementing of ISO 9001, ISO 17025 in pharmaceutical manufacturing unit, pharmaceutical regulatory affairs: Regulation and policy development for low and middle income countries (LCMIS), Global pharmaceutical and vaccine supply chain and logistics system management (PSM) and research, Antimicrobial resistance and management (AMR). A consultant with Pharmacy and Poison's Board of Kenya as a technical advisor in the expert committee for Pharmacy education and professional registration. She has managed funded projects as a PI and Co PI and I am compliant of grants management systems of various funding agencies and is proactive in networking and collaborating with strategic partners for training and capacity building in pharmaceutical sciences research and pharmaceutical management and supply chain.
Thomas Bizimana
Dr. Thomas BIZIMANA (BPharm, MSc, PhD) is a Lecturer at College of Medicine and Health Sciences, School of Medicine, and Pharmacy, Department of Pharmaceutical and Biopharmaceutical Analysis, and he is also a Deputy Research Coordinator at the East African Community's Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management (EAC RCE-VIHSCM), University of Rwanda. He has been engaged in academic and professional teaching, curriculum developments administration and community service at the National University of Rwanda (NUR) which is now University of Rwanda (UR), since 2008. He is a researcher and a reviewer. He has more than 10 works published in scientific journals and has reviewed four works for two scientific journals in the areas of Supply Chain Management for Health Commodities, Rational Medicine Use, and Instrumental Medicines Analysis.
Manassé Nimpagaritse
Manassé NIMPAGARITSE, MD, MPH, PhD is a medical doctor by initial training, specialist in public health, with experience in the Burundian health system of around 20 years. He has expertise in health systems organization, research on policies and health systems, health financing and more specifically performance-based financing. Holder of a PhD in Public Health conferred by the Université Catholique de Louvain (UCL) in Belgium, he is a full-time Teacher-Researcher-Lecturer at the Institut National de Santé Publique (INSP) of Burundi. He is also Head of the Public Health Research Coordination Department and coordinator of the Centre d'Excellence pour la Recherche et la Formation en Informatique de Santé (CERFIS) at the INSP. Manassé is currently co-promoter of two doctoral theses at the start-up stage respectively at the Vrije Universiteit Brussel (VUB) and at the Université libre de Bruxelles (ULB). Furthermore, he teaches in the master's cycle in Public Health at the INSP and that of the master's in nutrition and health, Nutrition and Public Health option at the East African Nutritional Sciences Institute of the University of Burundi. He is actively involved in supervising the end of Master's thesis work at INSP, EANSI, University of Ngozi in Burundi and the East African Community Regional Center of Excellence for Vaccines Immunization and Health Supply Chain Management (EAC RCE- HIVSCM) from the College of Medicine and Health Sciences in Rwanda for around thirty postgraduate students; the majority of the articles resulting from these works are at the advanced stage of the publication process in scientific journals.